So talk to you doctor about when and under what circumstances they do that particular procedure.

great advice. Also, talk to other doctors in the practice in case you go into labor when another doctor is on call.

Regarding vacuum: I had multiple (unsuccessful) attempts at vacuum extraction, and then forceps, and no episiotomy. It was an emergency situation (though we were prepped for ER, apparently not emergency enough for C section, so i don't think it was skipped for lack of time), and I did end up with a small tear. However, this was after baby A was born, so everything must have already been sort of loosened up. ^shudder^

I don't know why, but I feel a deep need to understand where exactly the cutting is taking place. Cause it doesn't really seem to me like there is much of anything to cut down there without running into things you really really shouldn't be cutting into. I'll be huddled in the corner with the others, awaiting a response.

So, sometimes the baby's head is just genuinely too big to get out. If you've got time (baby isn't in distress or anything), then you wait for the vaj to expand further and/or tear naturally. If you haven't got time or there are other complicating factors (maternal fatigue, etc), then you might cut to expedite things and/or to facilitate using an additional tool (vacuum extractor).

(ETA: I'm not sure if it's a necessity or just common, but it seems like you ALWAYS hear about an episiotomy when vacuum extraction is mentioned. )

I remember my doctor telling me that if the head could get out - that was the real trick. My kid's head was so big, he was actually stuck like a cork. He wasn't going anywhere without assistance.

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As far as location the cut (in my experience) is in the lower part of the perineum but isn't always directly toward the anus but rather off at a diagonal (read 5 or 7 o'clock). They can also get "fancy" and do a cut with a little jog to the side lovingly referred to as the Hockey stick which in some realm is supposed to prevent any tearing beyond the cut. I really wouldn't want to Google that!!!

_________________Did you notice the slight feeling of panic at the words "Chicken Basin Street"? Like someone was walking over your grave? Try not to remember. We must never remember. - mumblesIs this about devilberries and nazifruit again? - footface

I think it's important that episiotomies are not looked down on, it helped me and I don't regret it happening one bit. Parts of this thread are akin to c-section shaming and that isn't cool at all.

Overall, it's important to find a doctor or midwife whose beliefs on the subject align with your own.

And to realize that no matter how prepared you are, how many doctors or midwives you talk to, and how clear you are on your birth preferences, sometimes things happen at odd hours and you end up with a doctor you've never met, who may have a very different philosophy about birth. And in an emergency, things happen quickly, but everybody's doing the best they know how to keep mom and baby safe. Having interventions you never planned on does not mean you did birth wrong.

Yes to what Kelly and Mitten are saying! Its so much like the shaming of people who couldn't breastfeed that I see in the BF community, blaming women for their inability to BF. Unless you are a medical professional who has access to all the facts, you shouldn't be making judgements on another person's medical history and what was necessary or not.

_________________My oven is bigger on the inside, and it produces lots of wibbly wobbly, cake wakey... stuff. - The PoopieB.

I think it's important that episiotomies are not looked down on, it helped me and I don't regret it happening one bit. Parts of this thread are akin to c-section shaming and that isn't cool at all.

Overall, it's important to find a doctor or midwife whose beliefs on the subject align with your own.

And to realize that no matter how prepared you are, how many doctors or midwives you talk to, and how clear you are on your birth preferences, sometimes things happen at odd hours and you end up with a doctor you've never met, who may have a very different philosophy about birth. And in an emergency, things happen quickly, but everybody's doing the best they know how to keep mom and baby safe. Having interventions you never planned on does not mean you did birth wrong.

This is why I was trying to explain that you can't do an episiotomy unless the baby is crowning. The perineum looks a lot different with the pressure of a head stretching it. If you were to imagine (or google a picture...) of crowning, you would be able to see where the cut is happening.

tinglepants, I apologize if I've been unkind. It was not my intention.

I don't have conversations from the point of view that every personal experience somebody has (or their understanding of that experience) should change my theoretical viewpoint toward the universe or be equally weighed against the value of the evidence available. I stand by the opinion that medical science cannot progress without critiquing our practices and their value and I cannot even begin to comprehend how that is controversial or offensive in any way. It actually matters for the good of human health now and in the future that we say "we shouldn't have done x, y, and z because...." It also matters that we not view every experience as an exception to the rule because this is also the way practitioners justify continuing bad practices (it's amazing! 90% of my patients were exceptions to the rule!) and this is how they might justify their bad practice to you, their patient, to your detriment. I know that is psychologically difficult. I don't know how to say all of that in a way that doesn't feel "silencing."

I've not felt silenced at all, in this thread.

I am a little baffled, though, because I don't disagree with you in regards to episiotomy as routine. That's not what I was arguing in my original post, and when I gave anecdotal evidence, I clarified that I was neither applying these anecdotes to the majority, nor did I think the majority of women needed episiotomies.

What I'm arguing against is the prevalent use of language that frames an absolute; I don't think it's cool to say "this couldn't possibly happen based on everything I've read" when you're not a doctor, and you haven't been there to witness circumstances that are antithetical to what you've read. I don't mean to pick solely on you because I think this happens everywhere in this forum and I understand why: doctors have been and continue to be patriarchal jerks, and in order to steel ourselves enough to question them, we need to learn to believe in our own authority. And often, we do end up knowing better than a particular doctor. I got you there--my family has a fun health history of all sorts of things most doctors didn't believe existed until the past decade. I definitely get that the medical establishment doesn't know everything, and often what they do know is completely wrong.

Full confession: I'm actually a lot more well-read on birthing procedures/the bullshiitake history of the medical profession than I let on in my original post. I felt bad chiming in at all because I'm not a mother and I don't want to override anyone's real-life experience. But I stand by the responsibility to provide credible sources if one is making a "this is the way it absolutely is" statement.

And the Mayo Clinic and Johns Hopkins take a stance against routine episiotomy--any doctor who still automatically does it is not a good doctor.

_________________"So often I wish Adam were a real boy." - interrobang?!"If he was you'd hear him farting at the back of your yoga class." - 8ball

Joined: Fri Apr 01, 2011 11:51 amPosts: 6025Location: United States of New England

mooo wrote:

Rhizopus Oligosporus wrote:

My question was more where than why

This is why I was trying to explain that you can't do an episiotomy unless the baby is crowning. The perineum looks a lot different with the pressure of a head stretching it. If you were to imagine (or google a picture...) of crowning, you would be able to see where the cut is happening.

this is what confuses me about what my mom told me.she said she had no problems with the episiotomies (ie that they did them) but she remembers being mad because for my birth the doctor waited til i was "RIGHT THERE" (her words) so i didnt ask but i was thinking, if the baby wasnt RIGHT THERE how would you know you needed an episiotomy??? maybe it's me not understanding the different phases of labor but it made me think the one she got for my brother was more routine ie "yeah you're not gonna be able to do this so we're just gonna cut you" since it was the mid 70s rather than assessing the situation and making a call.

Having interventions you never planned on does not mean you did birth wrong.

This. So very much.

Like several others have posted, I had an episiotomy because of baby in distress and forceps delivery. I had anesthesia by that point, so I didn't feel a thing. The stitches themselves (oh my Lard, a lot of stitches!) healed really well and fairly quickly. I had (have) trouble with sitting/pain, etc. but from what I can gather a lot of that was from the use of the forceps, a subsequent prolapse and just the normal bruising/damage from birthing a giant baby.

I definitely wouldn't choose to have one again as routine, but if instrumental delivery were looking likely, then I think it would be the way to go.

<<chuckles thinking about the first time I discussed what an episiotomy was with my husband. I thought he might pass out. :D

tinglepants, glad to hear it and I again apologize for any confusion or distress as that was not my intention. I absolutely do not think you shouldn't participate in any conversation based on having children or not. I (obviously) do not think personal experience is the arbiter of very much at all and actually think over-reliance on personal experience usually clouds our judgment.

I do not think it is in any way shaming to say that something someone experienced should not be routine or isn't average or whatever. I do not feel at all shamed when people say that the vast majority of women should be able to breastfeed and I still believe that to be true even though I couldn't personally (and I would still believe that I should've been able to if I hadn't gone through sufficient rigamarole to prove to myself that I couldn't)! I wouldn't even find it shaming for someone to say I shouldn't have done x, y, or z in my own labor if more facts came to the forefront (like I now feel differently about how long to wait to be induced if my water breaks again without contractions - because I have had access to more information than I had then). And I definitely wouldn't find it shaming for someone to say that my provider shouldn't have done something or wasn't standing on firm evidence-based ground to do something, because that is a shame on them, not on me or my decision-making skills or my experience. Seriously, there's a difference between saying that the research doesn't support something or that something is not a normal indication for a procedure and saying, "You are bad, woman, why aren't you strong enough to push your baby out the right way?" Can we be a little less quick to think someone is trying to silence or shame someone else? I am sorry that my sensitivity level is not high enough around these things because I put my foot in it sometimes without intending to, but I also am sorry that people wouldn't give me the benefit of the doubt and know that I wasn't trying to be hurtful.

By the way, if anyone wants to see pictures of the different kinds of episiotomies, there are pictures in one of the links I put above.